Today, on 26th of March 2020, I am writing this editorial on very second day of complete lockdown in India due to attack by “coronavirus disease-19” (COVID-19). The large population of this vast country is locked up in their homes; very few are working to provide essential services. Among them, the doctors are in the forefront, taking bullet on their chest. Many statesperson, politicians, media anchors, and newspapers call them soldiers. This the first time in my life I am seeing positive signals for medical profession from every section of the society we serve. Few days back on 22 March, the day of “Janta curfew,” whole country clapped from their doors or balconies for persons providing essential services including health-care personnel. All this thrilled us momentarily but we know that the war is yet to be won. Being part of the same profession, we understand that these medical soldiers are fighting the deadly virus without having the effective weapons to counter them. It is more of a defensive battle without even having proper self-protection gear. In the last few days, many politicians and head of the states have commented that this war is no less than “World War II.” World War II lasted for almost 6 years. We only hope that war against “COVID-19” does not last that long. Like any other war in the history, this war is also being fought largely by the young people. The young resident doctors and specialists are in forefront, knowing fully well that it could kill them. I have served in “Armed Forces Medical Services” for 37 years, performing the dual role of a soldier and a doctor. It was always a great feeling when the whole country is behind you while you are battling the enemies. There is the commitment and resolve to win the war. The same commitment is now seen in the doctors tackling COVID-19. BMC (Brihanmumbai Municipal Corporation) advertised for 50 additional doctors from private sector to tackle the menace of COVID-19, instead they got 250. Such is the enthusiasm among the doctors. Many of the junior doctors I talked to are not averse to combat the virus, provided the proper protective gear, drugs, and equipment are provided, whereas others say that they are ready to “fight it with whatever they have.”

In the battle against COVID-19, the whole world is with the doctors. But unlike this, in many other adverse situations, the doctors are isolated and alone. To name a few––the legal battles, extortion by local mafia, harassment by regulatory bodies, violence by patients’ relatives, accusation of malpractice. Inadequate income to support parents, wife, and children is another cause of stress.

Legal issues and actions of law enforcement authorities

Four decades back, when we passed out of medical college, nobody ever talked about legal actions against the doctors. The doctors were highly respected in the society and even if the patient was not satisfied, they never went to the court. Today a sizable number of patients who do not get desired results go to court or threaten to go to court. Consumer court has further added to the woes of a doctor. At times, the compensation awarded by the court is disproportionate to the fees paid by the patient or earning by the doctor or the hospitals. There is no laid down limit. Not only the private doctors and hospitals, occasionally the cases against the government hospitals are also accepted by the consumer court though the patient has not paid any fee. Financial loss apart, the court cases run for years and psychologically affect the individual immensely. There are plenty of instances where the confidence of a surgeon or physician had gone down substantially after a court case is filed against him or her. Today entire medical fraternity is scared of legal battles. The fear is so much that the first thing a young medical graduate thinks of is taking “indemnity insurance” before starting the practice. The police high-handedness in cases with unexpected adverse outcome also demoralizes the doctor. For instance, one of my seniors who retired from defense services and joined a private hospital was arrested and put in the jail for 2 days on flimsy grounds before the bail could be arranged. Post this incident, he became extremely depressed and died within a year of the incident. There are many such incidents that demoralize the medical fraternity. The landmark Supreme Court ruling that no doctor should be arrested by police on grounds of negligence is a welcome news for all of us. However, the police have various means to harass the doctor such as frequent summons to report to police station.

Political parties, local mafia, and crowd violence

New trends have started in the country, especially in metros and big cities. Many patients’ relatives approach political parties for help to get better treatment in hospital and reduction in the cost of treatment. To show their strength, the party workers harass the doctor and behave rudely even when the doctor is polite and technically and ethically correct. All this is to show their voters their strength and utility. The local mafia is not behind in showing their might to the doctors and the hospitals. They come in bunch of five to six tough looking individuals to intimidate the treating doctors. Most of the time, they just look for an excuse to damage the hospital property, getting physical with the doctors, and create chaos. The violence by patients’ relatives has just become a norm. There are several incidents of grievous injuries to doctors by crowd. The prime example of the crowd violence or lynching is death of 73-year-old Dr. Deben Dutta who died of injuries after being assaulted by the relatives of a patient at a tea estate in Assam. Extortion and on-the-spot compensation in terms of a sizable amount of money is another trick up their sleeve. These events humiliate the doctors in front of their patients and undermine their confidence. The result of these insults is that the doctors start refusing the patients where outcome is not favorable. There are several laws already existing to protect doctors against violence. However, no one has ever been booked under those laws. The fault lies with us. Probably most of us do not want to get involved with a police case. There is some good news too. The central government is bringing more comprehensive bill for protection of doctors and health establishment against violence.

Financial stress and lack of trust

There is a general impression among the people that doctors are rich. It may be so in developed countries such as the United States and other European countries. However, the majority of doctors in India just remain middle class. If we take 500 richest people in India, we may not find a single doctor in them. After almost 20 years of rigorous studies, passing through NEET twice, their starting salary is just 60,000–80,000 per month. It is difficult to maintain a family in this meager pay especially in a mega city such as Mumbai. I have come across many young specialists who were under tremendous financial stress while they were in Mumbai, but there income improved more than five times when they moved to smaller towns. There expenditure also reduced substantially. I think there is already a reversal of trend from big cities to smaller towns due to financial reasons. Stress is also for those doctors who are running a nursing home. The expectations of the patients have also gone up. The patients expect five-star facilities without intentions to pay for it. Larger corporate and private hospitals are also under stress due to nonpayment of dues of Ex-servicemen Contributory Health Scheme (ECHS) and Central Government Health Scheme (CGHS) by the government organizations. As such ECHS and CGHS rates are so low that they hardly meet the expenditure incurred by the hospitals. The patients’ lack of trust in us also hurts us as a professional. Patients come to us with half-baked knowledge obtained from the Internet. With the availability of mobile phone and WhatsApp messaging, the doctor is on call 24h. This leaves no time for them to relax. To add to the woes, the patients do not pay any fee for advice on mobile.

To conclude, I would just like to say that the medical profession has undergone a sea change in past few decades. My advice to young specialists, who are just passing out, will be to move out of metros and go to smaller towns. “You will be better off financially, you will be respected and there will be very little chance of legal issues, police high handedness, violence by goons and patients’ relatives.”

However, this is not the time to dwell on negative points of the profession and give a sermon. This is the time to fight COVID-19 with all our might. We should not grumble about lack of facilities. We should improvise and fight with whatever we have.